ATI RN Medical Surgical Proctored Exam Newest
/ATI RN Medical Surgical Proctored Preparation
/ATI RN Medical Surgical Proctored Practice
Exam With Complete Questions And Correct
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1. Massive Upper GI Bleed – Priority Sequence (Ordered Response)
A 58-year-old male with cirrhosis and known esophageal varices arrives in the ED
actively vomiting bright red blood (approximately 800 mL in the last 20 minutes). He is
pale, diaphoretic, BP 76/42, HR 138 sinus tachycardia, SpO2 94% on room air, capillary
refill 5 seconds.
Place the following actions in the exact order the RN should perform them:
Establish two 16-gauge IV sites
Insert a large-bore OG/NG tube to low intermittent suction
Type and crossmatch for 6 units PRBCs
Administer pantoprazole 80 mg IV bolus
Administer octreotide 50 mcg IV bolus
Place patient in left lateral decubitus with HOB 30–45°
Transfuse uncrossmatched O-negative blood
Prepare for emergent EGD/intubation
Correct Order:
7→1→6→3→5→4→2→8
Very Long Rationale:
Active variceal hemorrhage is a leading cause of death in cirrhosis. ABCs + immediate
volume resuscitation supersede everything. Uncrossmatched O-negative blood is given
,first because the patient is exsanguinating (Class IV shock). Two large-bore IVs are
required for rapid transfusion. Left lateral + HOB up prevents aspiration. Octreotide
bolus reduces portal pressure within minutes (before PPI). Only after stabilization do we
place the NG tube and scope.
2. New-Onset Atrial Fibrillation with RVR – Unstable (Priority)
72-year-old female admitted for pneumonia suddenly becomes lethargic. Telemetry
shows atrial fibrillation with ventricular rate 178–192 bpm, BP 84/50, altered mental
status, cool clammy skin, urine output 10 mL past hour.
Which is the nurse’s priority intervention?
A. Administer metoprolol 5 mg IV push
B. Prepare for immediate synchronized cardioversion
C. Administer diltiazem 0.25 mg/kg IV over 2 minutes
D. Administer amiodarone 150 mg IV over 10 minutes
Correct Answer: B. Immediate synchronized cardioversion
Long Rationale: Unstable A-fib (hypotension + AMS + oliguria) = electrical
cardioversion with 120–200 J biphasic, sedated. Rate-control drugs are contraindicated
because they will worsen hypotension.
3. Acute Chest Syndrome in Sickle Cell Crisis (SATA – Very Long Stem)
A 19-year-old with sickle cell disease (HbSS) is day 3 of vaso-occlusive crisis. Today he
develops fever 39.1 °C, new oxygen requirement 4 L NC to keep SpO2 >92%, chest pain
8/10, new bilateral infiltrates on CXR, WBC 21,000, platelet count dropped from 320 to
142.
Select ALL interventions the nurse should anticipate:
A. Simple transfusion to goal hemoglobin 10 g/dL
B. Exchange transfusion (automated red cell exchange)
C. Broad-spectrum antibiotics (ceftriaxone + azithromycin)
D. IV opioids via PCA (morphine or hydromorphone)
E. Incentive spirometry 10× hourly while awake
F. Hydroxyurea 2,000 mg PO daily
G. Bronchodilators and chest physiotherapy
Correct Answers: A, B, C, D, E, G
,Rationale: Acute chest syndrome is the #1 cause of death in sickle cell. Requires
aggressive pain control, oxygen, incentive spirometry, antibiotics (covers community +
atypical), and transfusion (simple or exchange) to reduce HbS <30%.
4. Malignant Hyperthermia Intraoperatively (Priority Drug & Dose)
During general anesthesia with sevoflurane and succinylcholine, the patient’s
temperature rises from 37 °C to 40.6 °C in 15 minutes, ETCO2 climbs to 78 mmHg,
severe masseter and generalized rigidity, HR 158 sinus.
What is the immediate pharmacologic treatment and correct initial dose?
Correct Answer:
Dantrolene 2.5 mg/kg IV rapid push, repeat every 5–10 minutes until symptoms
controlled (usual total 10 mg/kg)
Rationale: Only dantrolene reverses MH by blocking calcium release from sarcoplasmic
reticulum. Must be given within minutes.
5. Compartment Syndrome vs Arterial Occlusion (Long Differentiation)
Client 9 hours post open reduction internal fixation of tibia. Severe leg pain 10/10
unrelieved by 12 mg morphine in 2 hours. Anterior compartment tense and woody, pain
dramatically worse with passive stretch of great toe, numbness between 1st and 2nd toe,
dorsalis pedis pulse still easily palpable 2+.
The orthopedic resident says “pulses are present so it can’t be compartment syndrome.”
What is the nurse’s best response and priority action?
Correct Answer:
“Palpable pulses do NOT rule out compartment syndrome — they can remain intact
until very late. We need compartment pressures measured STAT and prepare for
fasciotomy.”
Priority = measure pressures (delta pressure <30 mmHg = surgical emergency)
6. Tumor Lysis Syndrome – Cardiac Emergency Sequence
Client with large B-cell lymphoma 20 hours after starting R-CHOP. Labs: K 7.4 → ECG
shows peaked T waves, loss of P waves, QRS widening to 0.16 sec.
Correct sequence of medications:
Calcium gluconate 1 g IV over 5–10 min
Insulin 10 units regular + D50W 50 mL IV push
Sodium bicarbonate 50 mEq IV push
, Albuterol 10–20 mg nebulized continuously
Correct Order: 1 → 2 → 4 → 3
Rationale: Calcium stabilizes myocardium immediately, then shift potassium into cells
(insulin/glucose + albuterol), then bicarbonate last.
7. Post-Craniotomy Increased ICP – Cushing’s Triad + Herniation
Client day 1 after craniotomy for subdural hematoma. Suddenly becomes unresponsive,
BP 210/60 (widened pulse pressure), HR 48, irregular respirations, right pupil 7 mm
fixed, left 4 mm reactive.
Priority action?
Correct Answer: Immediate hyperventilation to PaCO₂ 30–35 mmHg + call
neurosurgery + prepare for mannitol 1 g/kg or 3% saline
Rationale: Cushing’s triad + unilateral dilated pupil = herniation emergency.
8. Necrotizing Fasciitis vs Cellulitis (Long Stem)
Client with diabetes presents with left lower leg pain ×3 days. Area is dark purple-black
with bullae, crepitus on palpation, patient septic (temp 39.8 °C, WBC 28,000, lactate
5.1).
What is the definitive treatment?
Correct Answer: Emergent surgical debridement in OR within hours + broad-spectrum
IV antibiotics (vanco + pip-tazo + clindamycin)
Rationale: Necrotizing fasciitis = surgical emergency; mortality >70% if surgery delayed
>6 hours.
9. Autonomic Dysreflexia – Complete Management
Spinal cord injury T4 complete injury develops sudden pounding headache, BP 224/118,
profuse sweating/flushing above nipple line, bradycardia 48 bpm.
Select ALL correct immediate actions:
A. Sit patient upright or elevate HOB ≥45°
B. Check Foley catheter for kinks/obstruction
C. Administer nifedipine 10 mg bite-and-swallow
D. Perform digital rectal exam to remove fecal impaction
E. Administer hydralazine 10 mg IV
F. Loosen tight clothing/abdominal binder
/ATI RN Medical Surgical Proctored Preparation
/ATI RN Medical Surgical Proctored Practice
Exam With Complete Questions And Correct
Answers |Already Graded A+||Brand New
Versions!!
1. Massive Upper GI Bleed – Priority Sequence (Ordered Response)
A 58-year-old male with cirrhosis and known esophageal varices arrives in the ED
actively vomiting bright red blood (approximately 800 mL in the last 20 minutes). He is
pale, diaphoretic, BP 76/42, HR 138 sinus tachycardia, SpO2 94% on room air, capillary
refill 5 seconds.
Place the following actions in the exact order the RN should perform them:
Establish two 16-gauge IV sites
Insert a large-bore OG/NG tube to low intermittent suction
Type and crossmatch for 6 units PRBCs
Administer pantoprazole 80 mg IV bolus
Administer octreotide 50 mcg IV bolus
Place patient in left lateral decubitus with HOB 30–45°
Transfuse uncrossmatched O-negative blood
Prepare for emergent EGD/intubation
Correct Order:
7→1→6→3→5→4→2→8
Very Long Rationale:
Active variceal hemorrhage is a leading cause of death in cirrhosis. ABCs + immediate
volume resuscitation supersede everything. Uncrossmatched O-negative blood is given
,first because the patient is exsanguinating (Class IV shock). Two large-bore IVs are
required for rapid transfusion. Left lateral + HOB up prevents aspiration. Octreotide
bolus reduces portal pressure within minutes (before PPI). Only after stabilization do we
place the NG tube and scope.
2. New-Onset Atrial Fibrillation with RVR – Unstable (Priority)
72-year-old female admitted for pneumonia suddenly becomes lethargic. Telemetry
shows atrial fibrillation with ventricular rate 178–192 bpm, BP 84/50, altered mental
status, cool clammy skin, urine output 10 mL past hour.
Which is the nurse’s priority intervention?
A. Administer metoprolol 5 mg IV push
B. Prepare for immediate synchronized cardioversion
C. Administer diltiazem 0.25 mg/kg IV over 2 minutes
D. Administer amiodarone 150 mg IV over 10 minutes
Correct Answer: B. Immediate synchronized cardioversion
Long Rationale: Unstable A-fib (hypotension + AMS + oliguria) = electrical
cardioversion with 120–200 J biphasic, sedated. Rate-control drugs are contraindicated
because they will worsen hypotension.
3. Acute Chest Syndrome in Sickle Cell Crisis (SATA – Very Long Stem)
A 19-year-old with sickle cell disease (HbSS) is day 3 of vaso-occlusive crisis. Today he
develops fever 39.1 °C, new oxygen requirement 4 L NC to keep SpO2 >92%, chest pain
8/10, new bilateral infiltrates on CXR, WBC 21,000, platelet count dropped from 320 to
142.
Select ALL interventions the nurse should anticipate:
A. Simple transfusion to goal hemoglobin 10 g/dL
B. Exchange transfusion (automated red cell exchange)
C. Broad-spectrum antibiotics (ceftriaxone + azithromycin)
D. IV opioids via PCA (morphine or hydromorphone)
E. Incentive spirometry 10× hourly while awake
F. Hydroxyurea 2,000 mg PO daily
G. Bronchodilators and chest physiotherapy
Correct Answers: A, B, C, D, E, G
,Rationale: Acute chest syndrome is the #1 cause of death in sickle cell. Requires
aggressive pain control, oxygen, incentive spirometry, antibiotics (covers community +
atypical), and transfusion (simple or exchange) to reduce HbS <30%.
4. Malignant Hyperthermia Intraoperatively (Priority Drug & Dose)
During general anesthesia with sevoflurane and succinylcholine, the patient’s
temperature rises from 37 °C to 40.6 °C in 15 minutes, ETCO2 climbs to 78 mmHg,
severe masseter and generalized rigidity, HR 158 sinus.
What is the immediate pharmacologic treatment and correct initial dose?
Correct Answer:
Dantrolene 2.5 mg/kg IV rapid push, repeat every 5–10 minutes until symptoms
controlled (usual total 10 mg/kg)
Rationale: Only dantrolene reverses MH by blocking calcium release from sarcoplasmic
reticulum. Must be given within minutes.
5. Compartment Syndrome vs Arterial Occlusion (Long Differentiation)
Client 9 hours post open reduction internal fixation of tibia. Severe leg pain 10/10
unrelieved by 12 mg morphine in 2 hours. Anterior compartment tense and woody, pain
dramatically worse with passive stretch of great toe, numbness between 1st and 2nd toe,
dorsalis pedis pulse still easily palpable 2+.
The orthopedic resident says “pulses are present so it can’t be compartment syndrome.”
What is the nurse’s best response and priority action?
Correct Answer:
“Palpable pulses do NOT rule out compartment syndrome — they can remain intact
until very late. We need compartment pressures measured STAT and prepare for
fasciotomy.”
Priority = measure pressures (delta pressure <30 mmHg = surgical emergency)
6. Tumor Lysis Syndrome – Cardiac Emergency Sequence
Client with large B-cell lymphoma 20 hours after starting R-CHOP. Labs: K 7.4 → ECG
shows peaked T waves, loss of P waves, QRS widening to 0.16 sec.
Correct sequence of medications:
Calcium gluconate 1 g IV over 5–10 min
Insulin 10 units regular + D50W 50 mL IV push
Sodium bicarbonate 50 mEq IV push
, Albuterol 10–20 mg nebulized continuously
Correct Order: 1 → 2 → 4 → 3
Rationale: Calcium stabilizes myocardium immediately, then shift potassium into cells
(insulin/glucose + albuterol), then bicarbonate last.
7. Post-Craniotomy Increased ICP – Cushing’s Triad + Herniation
Client day 1 after craniotomy for subdural hematoma. Suddenly becomes unresponsive,
BP 210/60 (widened pulse pressure), HR 48, irregular respirations, right pupil 7 mm
fixed, left 4 mm reactive.
Priority action?
Correct Answer: Immediate hyperventilation to PaCO₂ 30–35 mmHg + call
neurosurgery + prepare for mannitol 1 g/kg or 3% saline
Rationale: Cushing’s triad + unilateral dilated pupil = herniation emergency.
8. Necrotizing Fasciitis vs Cellulitis (Long Stem)
Client with diabetes presents with left lower leg pain ×3 days. Area is dark purple-black
with bullae, crepitus on palpation, patient septic (temp 39.8 °C, WBC 28,000, lactate
5.1).
What is the definitive treatment?
Correct Answer: Emergent surgical debridement in OR within hours + broad-spectrum
IV antibiotics (vanco + pip-tazo + clindamycin)
Rationale: Necrotizing fasciitis = surgical emergency; mortality >70% if surgery delayed
>6 hours.
9. Autonomic Dysreflexia – Complete Management
Spinal cord injury T4 complete injury develops sudden pounding headache, BP 224/118,
profuse sweating/flushing above nipple line, bradycardia 48 bpm.
Select ALL correct immediate actions:
A. Sit patient upright or elevate HOB ≥45°
B. Check Foley catheter for kinks/obstruction
C. Administer nifedipine 10 mg bite-and-swallow
D. Perform digital rectal exam to remove fecal impaction
E. Administer hydralazine 10 mg IV
F. Loosen tight clothing/abdominal binder
